Answer to clinical scenario 27.03.2012

Hey everyone,

You may remember the clinical scenario that was posted on the 27th of last month. Well, for those of you who were wondering what the actor was asked to do - if the candidate apologised for the accident with the lignocaine and stated that it was contraindicated in her father, the actor would stand up and shout 'you killed my father' and leave the room! Imagine that.

The correct way to handle that situation is to explain the situation in its totality, and explain that at the local anaesthetic concentration, lignocaine pretty much has no effect on the heart, so would play no role in contributing toward the patient's death. Of course, you would also get a senior to discuss the situation with you and the family together.

MRCP clinical scenarios only appear scary on paper. They are no more than regular scenarios encountered in clinical practice. Keep a cool head, and they are all a walk in the park.

More scenarios soon!

Cardio4mrcp team.

Case 1 - How will you handle this?

You are called to casualty to see an 81 year old man who has a background history of ischemic heart disease and hypertension. He is admitted with acute shortness of breath and is in atrial fibrillation with a ventricular rate of 162 bpm. His blood pressure is only 80/60 mmHg. He is in heart failure. He is being given oxygen, but the staff are having a lot of difficulty obtaining peripheral access. You insert a central line in, flush it to ensure it's patency, and give him some frusemide to help shift the fluid. Unfortunately a short while later, he arrests, and despite the best resuscitation efforts, he dies. While cleaning up the area, the staff mentions to you that the patient's daughter is in the waiting area and has no idea what is going on. While preparing yourself to go and speak to her, you notice that you injected lignocaine (used to anaesthetise the skin) into central line while flushing it instead of saline. Knowing fully what the effects of intravenous lignocaine can be in such a situation, you have to now speak to the daughter, who is anxious to know what is going on, as she is his main carer.

How will you go about handling this scenario? Submit your answers in the comments box and I will tell you what the daughter was instructed to do!

By the way, this was an actual scenario that I wrote for the exams. Good luck!

Vik

Mnemonic #1

Mnemonics are invaluable in remembering features and facts about different conditions in Cardiology. From time to time, I will post some mnemonics I have found on the internet on this blog. I hope you find them useful. I will try and keep them 'clean', but you all know that mnemonics that we all tend to remember are the 'inappropriate' ones :-) ! We kick off this thread with

Causes of Atrial Fibrillation (ARITHMATIC)

• Alcohol
• Rheumatic fever
• Idiopathic
• Thyrotoxicosis
• Hypertension
• Mitral stenosis / Myxoma
• Atrial septal defect
• Toxins
• Ischemic heart disease
• Cardiomyopathy (commonly dilated)

I got this online from here

Vik

Director E-Medilearn.org Limited

Website - www.cardio4mrcp.com